'Do not attempt resuscitation'--do standardised order forms make a clinical difference above hand-written note entries?
OBJECTIVE
To quantify any effect of Standardised Order Forms (SOFs), versus hand-written note entries for 'Do Not Attempt Resuscitation'--on the selection and survival of remaining cardiopulmonary resuscitation (CPR) attempts.


METHODS
A prospective, observational study in two UK Hospitals, comparing numbers, demographics and survival rates from CPR attempts for 2 years prior to and 2 years after the introduction of SOFs (the only change in DNAR policy).


RESULTS
There were 133 CPR attempts, representing 0.30% of the 44,792 admissions, pre SOFs and 147 CPR attempts representing 0.32% of the 45,340 admissions following the SOFs (p=0.46). The median duration of a CPR attempt was 11min prior to and 15min following the SOFs (p=0.02). Of the CPR attempts, there was no change in mean age (p=0.34), proportions occurring outside working hours (p=0.70) or proportions presenting with an initial shockable rhythm (p=0.30). Survival to discharge following CPR was unchanged (p=0.23).


CONCLUSIONS
The introduction of SOFs for DNAR orders was associated with a significantly longer duration of CPR (on average by 3-4min) but no difference in overall number, demographics or type of arrest or survival in the remaining CPR attempts.
Lewis
Keir Edward
KE
Prince Philip Hospital, Hywel Dda NHS Trust, Wales, SA14 8QF, UK. k.e.lewis@swansea.ac.uk
Edwards
Victoria Middleton
VM
Hall
Sian
S
Temblett
Paul
P
Hutchings
Hayley
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D003710:Demography; D004282:Documentation / Q000379:methods*; D005568:Forms and Records Control; D006236:Handwriting; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D016414:Resuscitation Orders; D016019:Survival Analysis; D055815:Young Adult